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Daher M, Farraj SA, El Hassan B. Management of Extra-articular Scapular Fractures: A Narrative Review and Proposal of a Treatment Algorithm. Clin Orthop Surg 2023; 15:695-703. [PMID: 37811516 PMCID: PMC10551685 DOI: 10.4055/cios23031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 10/10/2023] Open
Abstract
The management of scapular fractures can be either conservative or operative, but it is still unclear how to choose the treatment option. Scapular fractures can be classified anatomically into four types: scapular spine, scapular body, and scapular neck where the treatment is conservative most of the time except for certain indications that are specific to each one, and inferior angle of the scapula where the operative treatment yields the best results but conservative treatment can be contemplated in some cases.
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Affiliation(s)
- Mohammad Daher
- Department of Orthopedic Surgery, Hôtel Dieu de France, Saint Joseph University, Beirut, Lebanon
| | - Sami Abi Farraj
- Department of Orthopedic Surgery, Hôtel Dieu de France, Saint Joseph University, Beirut, Lebanon
| | - Bassem El Hassan
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
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Ogawa K, Matsumura N, Yoshida A, Inokuchi W. Nonunion of the so-called acromion: a systematic review with consideration of the terminology. Arch Orthop Trauma Surg 2023; 143:5727-5740. [PMID: 37314525 PMCID: PMC10449677 DOI: 10.1007/s00402-023-04912-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/16/2023] [Indexed: 06/15/2023]
Abstract
INTRODUCTION There is no widely accepted standard for the classification and treatment of traumatic acromion/scapular spine fracture nonunion due to the scarcity of this condition and the confusion of terminology. MATERIALS AND METHODS PubMed and Scopus were searched using "scapular fracture" and "acromion fracture" or "scapular spine fracture" as search terms. The inclusion criteria were English full-text articles concerning acromion/scapular spine fracture nonunion that described patient characteristics and presented appropriate images. The exclusion criteria were cases without appropriate images. Citation tracking was conducted to find additional articles and notable full-text articles written in other languages. Fractures were classified using our newly proposed classification system. RESULTS Twenty-nine patients (19 men, 10 women) with 29 nonunions were identified. There were four type I, 15 type II, and 10 type III fracture nonunions. Only 11 fractures were isolated. The mean period from initial injury to final diagnosis was 35.2 ± 73.2 months (range 3-360 months) (n = 25). The most frequent cause of delayed diagnosis was conservative treatment for fracture in 11 patients, followed by oversight by the physician in 8. The most common reason for seeking medical advice was shoulder pain. Six patients received conservative therapy, and 23 received operative treatment. Fixation materials included various plates in 15 patients, and tension band wiring in 5. Bone grafting was performed in 16 patients (73%, 16/22). Of the 19 surgically treated patients with adequate follow-up, the outcome was rated excellent in 79%. CONCLUSIONS Isolated acromion/scapular spine fracture nonunion is rare. Fracture type II and III, arising in the anatomical scapular spine, accounted for 86% of the fractures. Computed tomography is required to prevent fracture oversight. Surgical therapy produces good stable results. However, it is important to select the appropriate surgical fixation method and material after considering the anatomical characteristics of the fracture and stress on the fractured portion. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Kiyohisa Ogawa
- Department of Orthopedic Surgery, Eiju General Hospital, 2-23-16 Higashi-Ueno, Taito-ku, Tokyo, 110-8645, Japan.
- Department of Orthopedic Surgery, Eiju General Hospital, 2-23-16 Higashi-Ueno, Taito-ku, Tokyo, 110-8645, Japan.
| | - Noboru Matsumura
- Department of Orthopedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Atsushi Yoshida
- Department of Orthopedic Surgery, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako City, Saitama, 351-0102, Japan
| | - Wataru Inokuchi
- Department of Orthopedic Surgery, Eiju General Hospital, 2-23-16 Higashi-Ueno, Taito-ku, Tokyo, 110-8645, Japan
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Shi H, Zhang K, Hu Y, Wu W, Liu N, Lu H. Novel Claw-shaped Bone Plate in Complex Unstable Scapular Neck and Body Fractures: Comparison with Reconstruction Locking Plate. Orthop Surg 2023; 15:2124-2131. [PMID: 37226558 PMCID: PMC10432470 DOI: 10.1111/os.13766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE For complex and unstable scapular fractures requiring simultaneous fixation of the glenoid neck, the lateral margin of the body, and/or the scapular diaphysis, reconstruction locking plate is difficult to achieve satisfactory fixation. In order to optimize the fixation effect, the newly designed claw-shaped bone plate was designed for fixing such fractures. We also evaluate the clinical effects and follow-up at an average of 1 year after treatment in scapular internal fixation by using reconstruction locking plate and claw-shaped bone plate in complex unstable scapular body and glenoid neck fracture. METHODS A retrospective study was conducted from 2018 to 2021, thirty-three patients (27 males and six females) who were defined unstable scapular fractures by Ada-Miller. Fifteen patients (52.86 ± 8.26 years) received claw-shaped bone plate and 18 cases (51.61 ± 11.31 years) received reconstruction locking plate with the intermuscular approach. The clinical effect was evaluated based on the operation time, intraoperative blood loss, surgical complications, clinical healing time and Constant-Murley score (CMS). The data analysis by Student t, Mann-Whitney U test and Pearson's chi squared test. RESULTS Compared with reconstruction locking plate, the claw-shaped bone plate showed shorter operation time (102.73 ± 18.43 min vs. 156 ± 37.53, P < 0.0001), higher CMS (94.00 ± 4.07 vs. 89.88 ± 5.42, P = 0.02) and no differences between the two groups regarding intraoperative blood loss (208.00 ± 96.45 mL vs. 269.44 ± 120.21, P = 0.12) and clinical healing times (9.96 ± 1.52 vs. 10.05 ± 1.67, P = 0.87). Follow-up were conducted at first, third, 6 and 12 months after surgery. The operation was successful in all patients with no intraoperative complications. CONCLUSIONS For the treatment of complex and unstable scapular neck body fractures, the application of claw-shaped bone plate demonstrated short operation time, better stability of the fracture block, and higher CMS. In the intraoperative and postoperative follow-up showed better clinical results and rehabilitation effects.
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Affiliation(s)
- Huiming Shi
- School of Basic Medical SciencesXi'an Jiaotong UniversityXi'anChina
- Traumatic Orthopaedics DepartmentHanzhong Central HospitalHanzhongChina
| | - Kun Zhang
- Orthopaedics Department of Xi'an Honghui HospitalXi'anChina
| | - Yuanjun Hu
- Traumatic Orthopaedics DepartmentHanzhong Central HospitalHanzhongChina
| | - Wei Wu
- Traumatic Orthopaedics DepartmentHanzhong Central HospitalHanzhongChina
| | - Ning Liu
- Traumatic Orthopaedics DepartmentHanzhong Central HospitalHanzhongChina
| | - Haixia Lu
- School of Basic Medical SciencesXi'an Jiaotong UniversityXi'anChina
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Charilaou J, Dey R, Burger M, Sivarasu S, van Staden R, Roche S. Quantitative fit analysis of acromion fracture plating systems using three-dimensional reconstructed scapula fractures - A multi-observer study. SICOT J 2021; 7:36. [PMID: 34014164 PMCID: PMC8136237 DOI: 10.1051/sicotj/2021028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/17/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Surgical treatment of displaced acromial and scapula spine fractures may be challenging due to the bony anatomy and variable fracture patterns. This difficulty is accentuated by the limitations of the available scapular plates for fracture fixation. This study compares the quantitative fitting of anatomic scapular plates and clavicle plates, using three-dimensional (3D) printed fractured scapulae. METHODS Fourteen scapulae with acromion and spine fractures were used for this study. Computerized tomographic (CT) scans of the fractured scapulae were obtained from the Philips picture archiving and communication system (PACS) database of patients admitted to a tertiary teaching hospital in Cape Town, South Africa between 2012 and 2016. The reconstructed scapulae were 3D printed and the anatomical acromion and clavicle plates were templated about the fracture regions. The fit assessment was performed by five observers who classified the plates as no-fit, intermediate fit, and anatomical fit according to the surgical guidelines. RESULTS The 6-hole anterior clavicle plate performed better than any of the scapular plates as they were able to fit 45.7% of the fractured acromion, including the spine. Among the pre-contoured anatomical scapula plates, both the short and the long acromion plates could fit only 27.3% of the fractured acromion. The intraclass correlation coefficient was 0.965 suggesting excellent consensus among the five observers. CONCLUSION Clavicle plates were found to be better suited to fit around a scapula fracture in its acromion and spine region.
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Affiliation(s)
- Johan Charilaou
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa
| | - Roopam Dey
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa - Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, 7935 Cape Town, South Africa
| | - Marilize Burger
- Faculty of Medicine and Health Sciences, Division of Orthopaedic Surgery, Stellenbosch University, 7935 Cape Town, South Africa
| | - Sudesh Sivarasu
- Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, 7935 Cape Town, South Africa
| | - Ruan van Staden
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa
| | - Stephen Roche
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa
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Malovrh T, Podobnik B, Stupnik T. Surgical treatment of scapular malunion combined with chest deformity after trauma: a case report. J Shoulder Elbow Surg 2021; 30:e25-e29. [PMID: 32890680 DOI: 10.1016/j.jse.2020.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/13/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Tomaz Malovrh
- Department of Traumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
| | - Boris Podobnik
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Tomaz Stupnik
- Department of Thoracic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Zyskowski M, Pesch S, Greve F, Wurm M, von Matthey F, Pfeiffer D, Felix S, Buchholz A, Kirchhoff C. Concomitant Intra-Articular Glenohumeral Lesions in Fractures of the Scapula Body. J Clin Med 2020; 9:jcm9040943. [PMID: 32235465 PMCID: PMC7230789 DOI: 10.3390/jcm9040943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Scapula body fractures are rare injuries with an incidence of 1% of all fractures accounting for 3% to 5% of all upper extremity fractures. Fractures of the scapula commonly result from high-energetic trauma and fall from great height. While several studies focused on concomitant injuries of chest and head as well as the cervical spine, up to now in the common literature, no study exists analyzing the prevalence of concomitant intra-articular glenohumeral injury following extra-articular scapular fracture. Objectives: The aim of this study was to analyze the prevalence of concomitant intra-articular glenohumeral injuries in acute fractures of the scapula by performing magnetic resonance imaging (MRI) of the shoulder joint. Study Design and Methods: This prospective cohort study was performed at our academic Level I trauma center from November 2014 to October 2016. According to our clinical algorithm, all patients suffering from an acute scapula body fracture primarily underwent computed tomography (CT) for assigning the fracture according to the Orthopedic Trauma Association (OTA)-classification and therapy planning. In addition, 3 T MRI-scans of all patients were performed within seven days after trauma. Results: Twenty-one (16 male/5 female, mean age 53 years (25–83 y) patients with scapula body fractures (OTA 14.A3.2 80.1%, OTA 14.A3.1 4.8%, OTA14.B3.1 4.8%, OTA14.C3 9.5%) were enrolled. MRI revealed 11 acute intra-articular injuries in 8 of 21 patients (38%). In all 21 patients, hematoma of the rotator cuff and periarticular muscles was present. Three patients (14.3%) presented a partial bursa sided tear of the supraspinatus tendon, whereas in 5 (23.8%), a partial articular sided supraspinatus tendon tear and in 2 (9.5%) patients, a subtotal tear was observed. One patient (4.8%) showed a complete transmural supraspinatus tendon tear. Conclusions: Traumatic concomitant glenohumeral injuries in scapula body fractures seem to be more frequent than generally expected. Subsequent surgical treatment of these formerly missed but therapy-relevant injuries may increase functional outcome and reduce the postoperative complication rate following scapula body fractures.
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Affiliation(s)
- Michael Zyskowski
- Klinikum rechts der Isar, Technische Universität München, Klinik und Poliklinik für Unfallchirurgie, Ismaninger Str. 22, 81675 München, Germany; (M.Z.); (S.P.); (F.G.); (M.W.); (F.v.M.); (S.F.); (A.B.)
| | - Sebastian Pesch
- Klinikum rechts der Isar, Technische Universität München, Klinik und Poliklinik für Unfallchirurgie, Ismaninger Str. 22, 81675 München, Germany; (M.Z.); (S.P.); (F.G.); (M.W.); (F.v.M.); (S.F.); (A.B.)
| | - Frederik Greve
- Klinikum rechts der Isar, Technische Universität München, Klinik und Poliklinik für Unfallchirurgie, Ismaninger Str. 22, 81675 München, Germany; (M.Z.); (S.P.); (F.G.); (M.W.); (F.v.M.); (S.F.); (A.B.)
| | - Markus Wurm
- Klinikum rechts der Isar, Technische Universität München, Klinik und Poliklinik für Unfallchirurgie, Ismaninger Str. 22, 81675 München, Germany; (M.Z.); (S.P.); (F.G.); (M.W.); (F.v.M.); (S.F.); (A.B.)
| | - Francesca von Matthey
- Klinikum rechts der Isar, Technische Universität München, Klinik und Poliklinik für Unfallchirurgie, Ismaninger Str. 22, 81675 München, Germany; (M.Z.); (S.P.); (F.G.); (M.W.); (F.v.M.); (S.F.); (A.B.)
| | - Daniela Pfeiffer
- Klinikum rechts der Isar, Technische Universität München, Klinik und Poliklinik für Strahlentherapie und Radiologie, Ismaninger Str. 22, 81675 München, Germany;
| | - Sophie Felix
- Klinikum rechts der Isar, Technische Universität München, Klinik und Poliklinik für Unfallchirurgie, Ismaninger Str. 22, 81675 München, Germany; (M.Z.); (S.P.); (F.G.); (M.W.); (F.v.M.); (S.F.); (A.B.)
| | - Arne Buchholz
- Klinikum rechts der Isar, Technische Universität München, Klinik und Poliklinik für Unfallchirurgie, Ismaninger Str. 22, 81675 München, Germany; (M.Z.); (S.P.); (F.G.); (M.W.); (F.v.M.); (S.F.); (A.B.)
| | - Chlodwig Kirchhoff
- Klinikum rechts der Isar, Technische Universität München, Klinik und Poliklinik für Unfallchirurgie, Ismaninger Str. 22, 81675 München, Germany; (M.Z.); (S.P.); (F.G.); (M.W.); (F.v.M.); (S.F.); (A.B.)
- Correspondence: ; Tel.: +49-89-4140-5100
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Mohd Asihin MA, Bajuri MY, Ganaisan PK, Ahmad AR. Open Reduction and Internal Fixation of Extraarticular Scapular Neck and Body Fractures With Good Short Term Functional Outcome. Front Surg 2020; 6:71. [PMID: 31921885 PMCID: PMC6928001 DOI: 10.3389/fsurg.2019.00071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 11/29/2019] [Indexed: 11/13/2022] Open
Abstract
Background: The study aims to evaluate the short-term functional outcome of open reduction and internal fixation of extraarticular scapular neck and body fractures treated at our center over a period of 2-year duration at a tertiary referral center. Patients and Methods: Between October 2015 and October 2017, we operated on 20 extraarticular scapular neck and body fracture. Ten were available for a one-off assessment. The mean time to surgery was 10 days (range, 3–19 days) and one-off assessment was done within 6–24 months (mean, 13 months). Indications includes (1) medial/lateral displacement (M/L) ≥ 20 mm, (2) M/L ≥ 15 mm if angular deformity ≥ 30°, (3) Angular deformity ≥ 45°, (4) Double lesion of superior shoulder suspensory complex (SSSC), with displacement ≥10 mm in both lesion, (5) Glenopolar angle (GPA) ≤ 22°, and (6) open scapular fracture. The functional outcome was measured using range motion and strength. Patient-reported outcome was assessed using Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and Short-Form-36 (SF-36) version 1. Results: All patients achieved radiological union at time of assessment. None of the patients had post-operative complications. The mean DASH score was 19.3 (range, 1.7–39.3). All subcategories of SF-36 questionnaire scores between 70 and 89.6, with exception to REE (role limitations due to emotional problems) and REP (role limitations due to physical health). The average range of motion for the injured shoulders; forward flexion 157°, abduction 114°, and external rotation 42°. The strength of operated and non-operated shoulders, respectively, 6.5 and 8.1 kgF of forward flexion, 5.5 and 7.2 kgF of abduction, and 4.1 and 6.3 kgF of external rotation. Conclusion: Open reduction and internal fixation of surgically indicated scapular neck and body fracture is feasible with predictably good functional outcome. The reduced external rotation ROM and strength may be due to the use of Classic Judet approach, however we do not enough data to support this.
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Affiliation(s)
| | - Mohd Yazid Bajuri
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia Medical Centre, Hospital Canselor Tuanku Mukhriz, Kuala Lumpur, Malaysia
| | | | - Abdul Rauf Ahmad
- Department of Orthopaedics, Hospital Tuanku Ja'afar, Seremban, Malaysia
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The traumatic acromion fracture: review of the literature, clinical examples and proposal of a treatment algorithm. Arch Orthop Trauma Surg 2019; 139:651-658. [PMID: 30671623 DOI: 10.1007/s00402-019-03126-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Traumatic acromion fractures are rare and typically occur in patients with multiple fractures, which often delays diagnosis. Limited guidance exists on the treatment of these fractures. We present a review of the literature from the last 20 years and describe our experience in treating five patients-two conservatively and three with open reduction and internal fixations (ORIF). METHODS We used the U.S. National Library of Science database, MEDLINE®, to search for all pertinent publications from January 1999 to December 2017. Included were retrospective or prospective studies, including case series and case reports, describing treatment for traumatic acromion fractures and clinical and/or radiological outcomes. For our case reports, we present five patients with traumatic acromion fractures who were treated at our institution between 2013 and 2017. RESULTS Through our review of 14 publications, we found that current recommendations are often based on a limited number of cases. No gold standard to treat these fractures exists. Most authors recommend anatomic reconstruction, especially for dislocated fractures, persistent symptomatic non-unions or additional injuries to the superior shoulder suspensory complex. There is no clear trend in terms of the operative technique. With regard to our five clinical examples that were all initially treated conservatively, two were successful and three eventually required reconstruction with ORIF. Based on the findings of this review, we proposed a treatment algorithm for traumatic acromion fractures. CONCLUSIONS A classification system providing clear guidance on treatment options is needed. Although the non-union rate with conservative treatment is relatively high, it is not always painful or limiting to shoulder function, especially in elderly or less active patients. Fixation seems to be a more suitable treatment option for active patients who are more likely to require revision of symptomatic non-unions.
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